Author Archives: amcerlean

Advertising for Childhood Obesity

The federal government is taking a stand against childhood obesity, asking the food industry to change the way that it advertises unhealthy foods to children.  The ultimatum is basically change your food or stop targeting kids.  With cereal boxes covered in colorful cartoon characters and junk food companies offering entertaining online games, it is not hard to understand why children are drawn to these products.  However, the issue is becoming serious enough that the use of characters like Toucan Sam to sell products is being equated to the issue of Joe Camel, a cartoon used to advertise Camel cigarettes years ago before it was outlawed due to its appeal to children.  Will these companies be willing to make the changes?

This attack on the food industry is an attempt to change the marketing structure so that children are not being enticed into obesity.  Not surprisingly, many of the food companies responded negatively to the proposal.  They claim that they have already made several changes in their recipes, such as reducing sugar and using more whole grains, to create healthier products.  Kellogg, while they reported they would look into the proposal, was one of the company’s that claimed to have improved their recipe.

I looked at the label for Froot Loops, a cereal sold by Kellogg, and the first ingredient listed is sugar, not the healthiest start to the day.  To add support to the argument against them, there is also partially hydrogenated vegetable oil in the cereal.  This is a trans fat (aka the worst kind of fat) that not only increases levels of LDL (bad cholesterol) but also lowers levels of HDL (good cholesterol), which actually help protect against heart disease.  Over time, consumption of trans fats clogs arteries and increases susceptibility to developing heart disease.  Why should we risk the health of children and ourselves by not only consuming these products but also for allowing them to target younger populations?

The proposal presented to the food industry creates nutrition guidelines for companies advertising to children: 1) The product must contain certain healthful ingredients such as fruit, vegetables, or low-fat milk and 2) The product cannot contain unhealthful amounts of sugar, salt, saturated fat, and trans fat.  Sugar, for example, would be limited to 8 grams per serving, far less than the 12 grams that are in one serving of Froot Loops.  While companies like Kellogg have apparently made some changes to their formulas, it is necessary for the health of the consumer to continue creating a healthier product.

On a more positive note: When I recently stopped at a Wal-Mart to pick up a snack for my drive home, I grabbed mini bags of baby carrots.  I was surprised and excited to see advertisement for the new movie Hop on the bags of carrots! They were attempting to appeal to  children, sending out the message that carrots are an appealing and nutritious alternative to unhealthy junk foods.  This company was taking the tactics of companies like McDonald’s and Kellogg to promote healthy eating.  Cartoon characters sell products, so why not utilize this to sell healthy foods too?

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Licensed to Put Us All at-Risk?

This NY Times article about new drivers learning how to operate a vehicle caught my attention because 1) I have never really thought too much about this topic as a public health issue and 2) My 16-year-old sister recently got her driver’s license in October and I try to make sure she is well-informed and safe.  She went through the same process as I did to qualify for a license: driver’s ed (classroom and behind the wheel), hours of supervised driving, and a minimum of 6 months with a driver’s permit.  I always assumed this was standard for most states, but apparently some states allow children as young as 14 years old to begin driving with a permit, which seems awfully young.

If the rate of vehicle-related accidents is so high for the teenage age group, then it could be beneficial to pay more attention to this matter and evaluate what is the best process for learning to drive and being qualified for a license.  From my own experience, I think that the process I went through provided a decent base from which to work off of, but practice in real situations was definitely needed.  States that have passed laws making the license process more extensive have seen a 30% decrease in teenage highway fatalities.  Adding more supervised driving hours, limiting the number of passengers allowed in the car of a teenage driver, and increasing the driving age are just a few examples of these laws.  Those states have been successful thus far in their attempts to increase safety on the roads, so why not make changes nationally?

Teenage vehicle accidents are typically caused by errors like scanning mistakes and misjudging the speed of oncoming cars when turning left.   Another suggestion for increasing safe driving is “narrative driving,” which entails parents explaining to their teenage passengers exactly what they do as they drive, bringing attention to actions that are second nature to experienced drivers but unknown to newbies.  In the classroom, rules of the road can be taught memorized, but application is something that needs to be experienced.  By having parents or adult drivers explain how to drive, student drivers are exposed to more in-depth information for a variety of situations and driving skills.

Another major cause of teenage accidents is misjudging road conditions.  Taking a student driver out on the road in different weather conditions and at various points in the day allows for a more holistic training.  Parents often limit practice to the most optimal driving conditions.  By doing so, newly licensed teenagers will be more at risk for an accident if they are alone when they face harsh or difficult conditions for the first time.  Steering on icy roads and avoiding hydroplaning are two skills that require specific instruction.  Without knowledge of how to handle these situations, young drivers can place themselves and others in great danger.

In the U.S., learning to drive is a right of passage into young adulthood.  Based on statistics, it is also very risky and potentially fatal.  Passing laws to facilitate a safer learning experience and taking the time to teach student drivers in an active manner can save many lives and create a better environment on the roads.

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Another Left behind by Health Reform…

Monica’s discussion of the article on health reform and children is one example of the negative effects that these changes can have.  Similarly, this article from the NY Times addresses yet another potential consequence of change.  In recent years, many states have been cutting funds for Medicaid, leaving those who qualify with limited resources and options.  Many doctors and other health care providers are reluctant (or refusing) to take patients on Medicaid, especially practitioners who specialize.  They lose money on these patients compared with those who have private insurance, so the financial payoff is not there.

With the Affordable Care Act, there is a great influx of people applying for Medicaid that is expected to occur over the next few years (approximately 15-20 million more people enrolling monthly).  More people using government-paid insurance means less private insurance patients for health professionals.  Will this change their practices?  If they continue to refuse to help people on Medicaid, then the increase in the program really does not mean a whole lot for the newly covered, especially if they are in need of specialized care.

While the practitioners’ refusals themselves are threatening to the well-being of Medicaid recipients, the budget cuts that have been occurring nationwide are also problematic.  Louisiana’s current situation is depicted in the article, and according to reports, Medicaid payments in the state have been reduced 15-20% over the past two years.  Even with a Medicaid card in wallet, people are not getting the services that they need.  Medicaid is soon to be the nation’s largest insurer, and without addressing issues of budgets and acceptance of patients, people will not be taken care of in an effective manner.

People on Medicaid have difficulty finding doctors who will treat them, but when it comes to finding specialists like neurologists, psychologists or pulmonologists, it is nearly impossible.  Draven Smith is an 8-year-old who has been expelled twice due to disruptive behavior.  He has been diagnosed with ADHD, but his mother cannot find a mental health specialist who will treat him.  Not only does this child not have access to the help he needs, but he also cannot receive a proper education due to his condition.  Can this system be changed in a way that maximizes benefits for all who are covered?

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Effective Evacuation

We often focus on food, medication, and other concrete materials when discussing means of taking care of people.  In this article  regarding evacuation plans, the personal safety of a community is the central issue.  The recent events in Japan have brought to question the effectiveness of evacuation plans in times of crisis.  Here in the U.S., we have witnessed several natural disasters recently like Hurricane Katrina and Hurricane Rita for which the failure to execute evacuation plans had detrimental repercussions.

While it is essential to create evacuation plans in order to prepare for unsafe situations that might arise, it is impossible to account for all scenarios that might occur.  However, we can do what is humanly possible to have plans for events like the tsunami and the nuclear power plant situation in Japan.  In order for these plans to be effective, cities, states, and countries need to communicate with the communities around them regarding established plans to avoid mishaps.  Although officials were able to avoid issue, the evacuation plans for the Three Mile Island nuclear generating station in 1979 is a prime example of the consequences of lack of communication.  If needed, the people would have been stuck on the small bridge, leaving them exposed to harm with nowhere to go.  With massive numbers of people being moved at once from a single area, communication is critical.

Not only is it necessary to establish these plans, but they need to be known to the population and regularly updated to ensure maximum potential for success.  How can we make the best of the situation?  Issuing copies of important plans to residents, employers, and others involved could be a start.  Familiarity with an evacuation plan will be crucial in a highly stressful crisis.  Keeping people informed may lead to greater efficiency when evacuation is necessary, which can ultimately save more lives.  Another group that should be familiar with these plans are the officials involved, such as members of government or police and fire departments.  These are the people who have authority, so as leaders they need to be fully prepared.

One issue that I have never really thought of until reading this article is the evacuation of places like nursing homes and hospitals.  Plans for populations that cannot care for themselves, especially in crisis situations, would require more attention because they involve not only the people who need assistance but also those providing that aid.  Often means of transportation like buses would probably be needed to bring larger numbers of people to a safer location, increasing the amount of communication necessary for success.  I am now wondering, how many people are left out of these evacuation plans?  Who is not on that “evacuation bus”?  Can everyone be accounted for when crisis arises?

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America’s Well-Being

After our discussions on the various components that contribute to an individual’s well-being, when I came across “Mapping the Nation’s Well-Being” on the NY Times website, I was curious to check it out.  The interactive map of the United States colorfully displays the results of a phone survey regarding American citizens’ views on different aspects of life.  While the researchers covered most of the six dimensions we have defined in class, there are limitations to this study.  For example, because it was a phone survey, participants have to own a phone, which means that this survey leaves out various groups, such as the homeless population and people who cannot afford a phone.  The sample who participated in this survey may not be entirely representative of the nation as a whole, so the results cannot be generalized.

While there are limitations to this study, several trends can be seen among the various entities of well-being.  The southern portion of the United States, especially the southeast, typically answered more negatively.  These individuals were more likely to express health problems, such as higher rates of diabetes, greater percentage of the population reporting obesity, and more reports of high cholesterol.  This region also indicated lower percentage of health insurance coverage.  Whether poor health status results from lack of insurance or lack of insurance worsens an already present condition, the two are correlated.

Other aspects that appeared to be lacking in the southern region were personal security and self-determination.  The map shows that inadequate food, inadequate shelter, and nighttime safety were issues reported at a greater rate in the south over the northern U.S.  These basic resources are crucial not only for people to prosper but for them to survive.  Without adequate amounts of these necessities, the dimensions of well-being will be insufficient.  If an individual does not have enough food, he or she may become malnourished, which can lead to various health problems.  The interdependency of the dimensions creates a complex system that requires effortful maintenance.

As I noted above, there are some limitations to this study, but the trends seen on the map indicate that there is variability of basic needs within our country.  These types of trends are what need to be acknowledged for effective change to be made.  If one region is lacking in food, affordable health care services, or other resources, then the efforts to gain sufficiency should be tailored to the needs of that community.  This map may not necessarily be representative of the entire U.S. population, but I thought it was an interesting visual based on what we have been discussing.

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The Cost of Popularity

Recently, bullying has been seen in the media more often– unfortunately, it is often because these destructive acts have led to suicide and acts of violence.  The traditional view of bullying involves a higher status or tough individual intimidating and/or hurting a weak person who has low social status.  As the author of this NY Times article conveys, bullying in high school now involves people who are considered rivals and often occurs in the middle to high social status class.  This mean of increasing one’s social status may not be a typical public health issue, but it is a great threat to well-being.  Powers and Faden’s dimensions of well-being can be used to analyze bullying and to highlight the need for intervention.

Personal Security- This one may be a little more obvious, but if an individual is bullied (whether at school, work, or even at home), his or her sense of personal security is violated and potentially nonexistent.  The fear of being hurt physically and mentally can disrupt daily functioning and affect one’s performance in activities.  If people feel unsafe in their environment, they cannot focus on responsibilities and other activities.  How are people supposed to accomplish goals, enjoy hobbies, or form relationships if they live in constant fear?

Health- Living with fear for one’s safety can take a great toll on one’s mental health.  Some repercussions of anxiety include increased heart rate, difficulty sleeping, muscle aches, and nausea.  Bullying may also include physical abuse, resulting in additional negative health consequences.

Reasoning- School is supposed to be a place where one can study subjects like math, science, and history while learning social and other life skills.  However, if bullying occurs at school, the victim may not be able to focus on academics and may avoid or not be permitted (by the bully) to participate in social activities.  Bullying can disrupt this important time for learning and growing.  In addition, the fear and anxiety that can accompany being bullied may cause an individual to be irrational and believe that there will be no end to the abuse.  As stated earlier, the media has brought attention to more cases of death and violence that have resulted from bullying.  In these cases, the bullying, fear, and embarrassment impaired these individuals’ reasoning, resulting in devastating consequences.

Self-Determination- The victim of bullying may lose self-determination if the bully does not allow him or her to do certain things.  In movies, the schoolyard bully is often seen taking lunch money, restricting where the victims can sit in the lunchroom, and making a victim do his or her homework.  While movies and television are not always accurate sources, the idea that a bully has some control over the victim’s actions does translate to real life situations.  Intimidation is often a strong and effective force.  If one fears the consequences of not complying with the bully’s demands or tries to avoid interaction with the bully, he or she may deviate from what is desired for the self and do what is necessary for self-preservation.

Respect- The victim of bullying is not respected by the perpetrator.  The abuse may also result in a lack of self-respect and feelings of worthlessness.  By hurting someone physically and mentally, the bully is treating the person as if his or her well-being is insignificant.  How can someone have so little respect for a person that he or she thinks hurting the person is acceptable and enjoyable?

Attachment-  The article describes bullying as a means to gain popularity.  A “friend” might turn on you if it means gaining social status.  Forming meaningful relationships in which respect, support, and trust are present may be difficult for a bullied individual, especially if the bully was once considered a friend.  Others may side with the bully in order to avoid being bullied themselves, further limiting social interaction and peer support for the victim.

I typically associate bullying with children and adolescents, but this issue extends into adulthood as well.  Whether it is competition in the workplace, hazing, or even hurtful gossiping among friends, bullying takes many forms and exists at every age level.  The issue itself is important, but it is also worth acknowledging the role of bystanders.  It can be intimidating to speak out against an individual or group if you witness bullying, especially when the bully is a peer or a friend.  However, the effects of harmful words and actions can be devastating, so it is crucial that schools continue to acknowledge this issue from an early age and that all ages recognize that each person deserves respect and the right to live free of intimidation.

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Early Detection: Is It Effective?

Thus far in class, we have discussed health promotion and disease prevention as two central goals of the Public Health field.  However, several Dartmouth researchers and doctors claim that early detection and screenings can lead to “overdiagnosis” and health issues that would have never occurred naturally.  With this conflicting message, I wonder- what is the best way to maximize health without causing harm?

One of the physicians, Dr. Welch, claims that a patient should be screened if he or she falls at the right spot on a “spectrum” between looking for early signs and already experiencing symptoms.  However, the doctor does not define the conditions that qualify a person to be classified as ready for testing.   Some tests can be expensive, invasive, and uncomfortable, but is it acceptable to put a limit on someone’s health and peace of mind?

Welch argues that doctors are overdiagnosing because they cannot identify who the people are that will never develop a life-threatening condition, so they treat everyone showing some abnormality.  Therefore, early detection is causing harm because even people who cannot “benefit” from treatment are receiving it.  Even if a disease is not life-threatening, it can still have a negative impact on an individual’s life and well-being.  Whether it is taking time off from work, not having enough energy to spend time with one’s kids, or having scars from a procedure, people can experience damage from diseases at all levels.  It is unethical to deny someone the opportunity to avoid these negative effects simply because he or she may not become deathly ill.

The Dartmouth crew does make a couple valid points.  For example, Dr. Welch says that some wellness programs have gotten away from educating people on healthy behaviors and how to manage their health.  Education is crucial to any wellness program.  If an individual does not know how to exercise properly or why eating vegetables, fruits, and whole grains is important to a healthy diet, he or she may be more reluctant to adopt and maintain these behaviors.  In this case, I agree with the researchers.

Overall, I do not understand how getting the recommended annual screenings for diseases like breast cancer could be seen as unnecessary.  Living a healthy lifestyle can prevent the onset of some diseases, but factors like genetics cannot be controlled.  Why risk waiting until it is too late and permanent damage has been done to be treated for a disease?  People deserve to be comfortable and confident that they are receiving the necessary care to keep them functioning at an optimal level.  Health promotion and disease prevention complement each other to create a well-rounded plan for keeping individuals and populations healthy.

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